Provider Demographics
NPI:1902199219
Name:JASIM, MUHAMMAD (PT)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:JASIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1544
Mailing Address - Country:US
Mailing Address - Phone:610-570-4307
Mailing Address - Fax:484-891-0608
Practice Address - Street 1:623 W UNION BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3708
Practice Address - Country:US
Practice Address - Phone:610-570-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027862200Medicaid